Ophthalmology Unit, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Via Savi, 10, 56126, Pisa, Italy.
Graefes Arch Clin Exp Ophthalmol. 2021 Apr;259(4):949-956. doi: 10.1007/s00417-020-05025-8. Epub 2020 Dec 1.
To estimate the frequency of epiretinal membrane (ERM) in eyes with primary open-angle glaucoma (POAG) treated with Ex-Press shunt implant. Secondarily, we aimed to assess the role of concomitant cataract surgery and the impact of the ERM on central foveal thickness and macular volume.
In this prospective, consecutive, case-control study, we enrolled 54 patients affected by PAOG and scheduled for Ex-Press device implant with or without contemporary phacoemulsification. Contralateral eyes affected by POAG and receiving anti-glaucomatous eyedrops constituted the control group. Complete ophthalmologic evaluation and spectral-domain optical coherence tomography (OCT) were performed before and 1, 3 and 6 months after surgery.
Twenty-six eyes received the Ex-Press implant alone, and 28 eyes underwent the combined procedure. Six months postoperatively, we observed 18 (33%) cases of ERM: 15 (28%) of cellophane macular reflex (CMR) and 3 (6%) of pre-macular fibrosis (PMF). In the control group, 9 (17%) eyes developed an ERM: 8 (15%) were CMR, and 1 (2%) was PMF. The frequency of ERM statistically differs between treated and contralateral eyes (P = 0.032, χ test). The ERM frequency did not statically differ between eyes subjected to simple or combined surgery (P = 0.846, χ test). Mean central foveal thickness and mean macular volume did not significantly differ between groups.
The Ex-Press glaucoma shunt may increase the risk of ERM onset regardless of the concomitant cataract surgery; however, most cases were cellophane macular reflex with limited functional and anatomical impact.
评估原发性开角型青光眼（POAG）患者行 Ex-Press 引流植入术后发生视网膜内表面膜（ERM）的频率。其次，我们旨在评估同期白内障手术的作用以及 ERM 对视神经中央凹厚度和黄斑容积的影响。
在这项前瞻性、连续的病例对照研究中，我们纳入了 54 例患有 POAG 并计划行 Ex-Press 设备植入术的患者，这些患者同时或不同时接受白内障超声乳化术。对侧眼患有 POAG 并接受抗青光眼滴眼液治疗的患者构成对照组。所有患者在术前、术后 1、3 和 6 个月进行全面的眼科评估和频域光相干断层扫描（OCT）检查。
26 只眼单独接受了 Ex-Press 植入术，28 只眼接受了联合手术。术后 6 个月，我们观察到 18 例（33%）出现 ERM：15 例（28%）为细胞层黄斑反射（CMR），3 例（6%）为黄斑前纤维（PMF）。在对照组中，9 只眼（17%）出现 ERM：8 例（15%）为 CMR，1 例（2%）为 PMF。治疗眼与对侧眼的 ERM 发生率存在统计学差异（P=0.032，卡方检验）。单纯手术和联合手术眼的 ERM 发生率无统计学差异（P=0.846，卡方检验）。两组间平均中央凹视网膜厚度和平均黄斑容积无显著差异。
Ex-Press 青光眼引流管的使用可能会增加 ERM 发病风险，无论是否同时行白内障手术；然而，大多数病例为细胞层黄斑反射，对功能和解剖结构的影响有限。
